Body Dysmorphic Disorder - Dysmorphophobie

 

 Buy Article Permissions and Reprints

Zusammenfassung

Im Gegensatz zu klassischen, psychiatrischen Erkrankungen ist die Dysmorphophobie eine schwierig zu stellende Diagnose. Dysmorphophobie hat sich von einem vagen Krankheitsbild zu einer definierten psychiatrischen Erkrankung gewandelt. Dysmorphophobie, im englischen Sprachgebrauch als Body dysmorphic disorder (BDD) bezeichnet und klassifiziert, ist eine Erkrankung, die häufig bei Patienten mit dem Wunsch nach ästhetischer Chirurgie gefunden wird. Die Dysmorphophobie als psychiatrische Erkrankung kann nicht chirurgisch geheilt werden, daher ist es für plastische Chirurgen wichtig, diese rechtzeitig zu diagnostizieren. Aufgrund der Erfahrungen sind die meisten plastischen Chirurgen sehr zurückhaltend mit einer Indikationsstellung bei Patienten mit Dysmorphophobie. Dies nicht nur aufgrund von etwaigen juristischen Problemen, sondern auch aufgrund von Unzufriedenheit, Anfeindungen und sogar Gewalt gegen den Chirurgen und die Angestellten. Die Diagnose der Dysmorphophobie zu stellen ist nicht nur sehr anspruchsvoll, sondern auch dem Patienten schwierig zu vermitteln. Aufgrund der Marktlage, bei der in einem aggressiv beworbenen Umfeld ästhetischer Chirurgie eine Ablehnung der Patienten oft als geschäftlicher Nachteil spürbar wird, erfordert es Mut, diese Diagnose zu stellen. Gerade deshalb sollte die Dysmorphophobie jedem Chirurgen geläufig sein.

Abstract

Body dysmorphic disorder (BDD) is a rare disease. Although described in the last century it was only recently classified in the DSM-IV. BDD is characterized by an excessive concern about an imagined deformity of the body. Establishing the diagnosis of BDD remains to be demanding, yet of utmost importance for the surgeon. Only a timely diagnosis will prevent dissatisfaction of both the patient and the surgeon. In this article, strategies to cope with such patients after diagnosis are described.

Literatur

• 1 Albertini RS, Phillips KA. 33 cases of body dysmorphic disorder in children and adolescents.  J Am Acad Child Adolesc Psych. 1999;  38 453-457
  PubMedGoogle Scholar
• 2 Altamura C, Paluello MM, Mundo E. Clinical and subclinical body dysmorphic disorder.  Eur Arch Psychiatry Clin Neurosci. 2001;  251 105-112
  CrossrefPubMedGoogle Scholar
• 3 American Psychiatric Association .Diagnostic and statistical manual of mental disorders (DSM-IV). 4^th ed. Washington, D.C.: American Psychiatric Association 1994
  Google Scholar
• 4 Andreasen NC, Bardach J. Dysmorphophobia: symptom or disease?.  Am J Psychiatry. 1977;  134 673-680
  PubMedGoogle Scholar
• 5 Bürgy M. Dysmorphophobia: Becoming estranged with oneself as a disorder of communication.  Nervenarzt. 1998;  69 446-453
  CrossrefPubMedGoogle Scholar
• 6 Crisp AH. Dysmorphophobia and the search for cosmetic surgery.  Br Med Surg. 1981;  282 1099-1112
  PubMedGoogle Scholar
• 7 Edgerton MT, Langman MW, Pruzinsky T. Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients.  Plast Reconstr Surg. 1991;  88 594-599
  CrossrefPubMedGoogle Scholar
• 8 Edgerton T, Jacobson WE, Meyer E. Surgical- psychiatric study of patient seeking plastic surgery: ninety-eight consecutive patients with minimal deformity.  Br J Plast Surg. 1961;  13 136-142
  PubMedGoogle Scholar
• 9 Fukuda O. Statistical analysis of dysmorphophobia in out-patient clinic.  Jpn J Plast Reconstr Surg. 1977;  20 569-575
  PubMedGoogle Scholar
• 10 Goin JM, Goin MK. Changing the body - Psychological effects of Plastic Surgery. Baltimore, USA: Williams and Wilkins Company 1981
• 11 Goin MK, Rees TD. A prospective study of patients’ psychological reactions to rhinoplasty.  Ann Reconstr Surg. 1991;  27 210-220
  CrossrefPubMedGoogle Scholar
• 12 Groenman NH, Sauer HC. Personality characteristics of the cosmetic surgical insatiable patient.  Psychother Psychosom. 1983;  40 241-249
  PubMedGoogle Scholar
• 13 Hollander E, Allen A, Kwon J. Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness.  Arch Gen Psych. 1999;  56 1033-1042
  CrossrefPubMedGoogle Scholar
• 14 Ishigooka J, Iwao M, Suzuki M. Demographic features of patients seeking cosmetic surgery.  Psychiatry Clin Neurosci. 1998;  52 283-289
  CrossrefPubMedGoogle Scholar
• 15 McKay D. Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder.  Behav Mod. 1999;  23 620-623
  PubMedGoogle Scholar
• 16 Ladee GA. Hypochondrial syndromes. Amsterdam: Elsevier 1966
• 17 Morselli E. Sulla dismorfofobia e sulla tafefobia.  Bull Acad Med Genova. 1886;  6 110-115
  PubMedGoogle Scholar
• 18 Mühlbauer W, Holm C, Wood DL. The Thersites Complex in plastic surgery patients.  Plast Reconstr Surg. 2001;  107 319-323
  CrossrefPubMedGoogle Scholar
• 19 Perugi G, Akiskal HS, Gianotti D. Gender-related differences in body dysmorphic disorder (dymorphophobia).  J Nerv Ment Dis. 1997;  185 578-583
  CrossrefPubMedGoogle Scholar
• 20 Perugi G, Giannotti D, Di Vaio S. Fluvoxamine in the treatment of body dysmorphic disorder (dysmorphophobia).  Int Clin Psychopharmacol. 1996;  11 247-251
  PubMedGoogle Scholar
• 21 Pertschuk MJ, Sarwer DB, Wadden TA, Whitaker LA. Body image dissatisfaction in male cosmetic surgery patients.  Aesthetic Plast Surg. 1998;  22 20-27
  PubMedGoogle Scholar
• 22 Phillips KA, Gunderson CG, Mallya G. A comparison study of body dysmorphic disorder and obsessive-compulsive disorder.  J Clin Psychiatry. 1998;  59 568-573
  CrossrefPubMedGoogle Scholar
• 23 Phillips KA, Hollander E. Body dysmorphic disorder. In DSM IV Sourcebook Vol 2 American Psychiatric Press, Washington, DC, USA 1996: 949-960
  Google Scholar
• 24 Phillips KA, Dufresne RG. Body dysmorphic disorder: A guide for dermatologists and cosmetic surgeons.  Am J Clin Dermatol. 2000;  1 235-244
  CrossrefPubMedGoogle Scholar
• 25 Phillips KA, Diaz S. Gender differences in body dysmorphic disorder.  J Nerv Ment Dis. 1997;  185 570-576
  CrossrefPubMedGoogle Scholar
• 26 Phillips KA, Atala KD, Pope HG. Diagnostic instruments for body dysmorphic disorder. New Research program and Abstracts, American psychiatric Association 148th annual meeting 1995 Miami, American Psychiatric Association
  Google Scholar
• 27 Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness.  Am J Psychiatry. 1991;  148 1138-1145
  CrossrefPubMedGoogle Scholar
• 28 Phillips KA, McElroy SL, Lion JR. Body dysmorphic disorder in cosmetic surgery patients.  Plast Reconstr Surg. 1992;  90 333-338
  PubMedGoogle Scholar
• 29 Phillips KA, McElroy SL, Keck PE. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases.  Psychopharm Bull. 1994;  30 179-184
  PubMedGoogle Scholar
• 30 Phillips KA, McElroy SL, Keck PE. Body dysmorphic disorder: 30 cases of imagined ugliness.  Am J Psychiatry. 1993;  150 302-309
  CrossrefPubMedGoogle Scholar
• 31 Phillips KA. The broken mirror: understanding and treating body dysmorphic disorder. New York: Oxford University Press 1996
  Google Scholar
• 32 Phillips KA, Dwight MM, McElroy SL. Efficacy and safety of fluvoxamine in body dysmorphic disorder.  J Clin Psychiatry. 1998;  59 165-170
  PubMedGoogle Scholar
• 33 Sarwer DB, Crerand CE, Didie ER. Body dysmorphic disorder in cosmetic surgery patients.  Facial Plast Surg. 2003;  19 7-12
  Article in Thieme ConnectPubMedGoogle Scholar
• 34 Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients.  Plast Reconstr Surg. 1998;  101 1644-1650
  CrossrefPubMedGoogle Scholar
• 35 Sarwer DB, Whitaker LA, Pertschuk MJ. Body image concerns of reconstructive surgery patients: an underrecognized problem.  Ann Plast Surg. 1998;  40 403-408
  CrossrefPubMedGoogle Scholar
• 36 Simeon D, Hollander E, Stein DJ. Body dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder.  Am J Psychiatry. 1995;  152 1207-1213
  PubMedGoogle Scholar
• 37 Thomson JA, Knorr NJ, Edgerton MT. Cosmetic surgery: the psychiatric perspective.  Psychosom. 1978;  19 7-15
  PubMedGoogle Scholar
• 38 Veale D, Boocock A, Gournay K. Body dysmorphic disorder: a survey of fifty cases.  Br J Psychiatry. 1996;  169 196-201
  PubMedGoogle Scholar
• 39 Veale D, Gournay K, Dryden W. Body dysmorphic disorder: a cognitive behavioral model and pilot randomized controlled trial.  Behav Res Ther. 1996;  34 717-721
  CrossrefPubMedGoogle Scholar
• 40 Wilhelm S, Otto MW, Lohr B. Cognitive behavior group therapy for body dysmorphic disorder: a case series.  Behav Res Ther. 1999;  37 71-78
  PubMedGoogle Scholar
• 41 Wright MR. The male aesthetic patient.  Arch Otolaryngol Head Neck Surg. 1987;  113 724-729
  PubMedGoogle Scholar

Korrespondenzadresse

Dr. Michael Jakubietz

Klinik für Hand-, Plastische und Wiederherstellungschirurgie

Kantonsspital St. Gallen

Rorschacherstr 85

CH- 9007 St. Gallen

Phone: 0041/714/94 11 11

Email: michael.jakubietz@kssg.ch